DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 150 S. Independence Mall West Suite 216, The Public Ledger Building Philadelphia, Pennsylvania 19106-3499

Region III/Division of Medicaid and Children’s Health Operations

SWIFT #012420144023

Cynthia Beane, MSW, LCSW Acting Commissioner Bureau for Medical Services 350 Capitol Street, Room 251 Charleston, West Virginia 25301-3706

Dear Acting Commissioner Beane:

The Centers for Medicare & Medicaid Services (CMS) has completed its review of West Virginia’s State Plan Amendment (SPA) 13-0017. This SPA clarifies the authority and responsibilities of the Single State Agency and its relationship to other Federal and State agencies, the fair hearings process, and the process for determining eligibility. We are pleased to inform you that this SPA is approved with an effective date of October 1, 2013.

Enclosed is a copy of the CMS Summary Page (CMS-179 form), the approved State Plan pages for A-1 through A-3, the Attorney General Certification, and the Bureau for Medical Services’ Organizational Chart.

We appreciate the cooperation and effort provided by your staff throughout this process. If you have further questions about this SPA, please contact Dan Belnap of my staff at 215-861-4273.

Sincerely,

Francis McCullough Associate Regional Administrator

Enclosures

September 19, 2016

Signature of Regional Official:

Title: Associate Regional AdministratorDate: September 19, 2016

Date Approved: September 16, 2016

TN No. 13-0017 West Virginia

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Effective Date: October 1, 2013

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Effective Date: October 1, 2013

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Effective Date: October 1, 2013

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Effective Date: October 1, 2013

ATTACHMENT 1-1-A STATE PLAN UNDER TITLE XIX OF THE SOCfAL SECURITY ACT

MEDICAL ASSISTANCE PROGRAM

State of _________ W_es_ t_Y_ i...,rg.._i_n _ia __________ _

ATTORNEY GENERAL'S CERTIFICATION

I certify that:

The Bureau for Medical Services is the single State agency responsible for:

x_ administering the plan.

The legal authority under which the agency administers the plan on a statewide basis is:

W. Va. Code § 9-l-2(n) ( defining "state medicaid agency" as "the division of the department of healthand human resources that is the federally designated single state agency charged with administrationand supervision of the state medicaid program"); W. Va. Code§ 9-2-5 (general authority ofDHHR toadminister "welfare assistance programs"); W. Va. Code § 9-2-6(12) (authorizing the Secretary tosubmit state plans); W. Va. Code§ 9-2-6(18) (authorizing DHHR Secretary to delegate powers andauthority); W. Va. Code§ 9-2-13(a)(3) (defining BMS as the "single state agency for Medicaidservices in West Virginia); and Appalachian Regional Healthcare, Inc. v West Virginia Dept. of Healthand Human Resources, 232 W. Va. 388,391, 752 S.E.2d 419,422 (2013) (recognizing that BMS is thesingle state agency)

(Legal Authorities)

supervising the administration of the plan by local political subdivisions.

The legal authority under which the agency supervises the administration of the plan on a statewide basis is contained in:

(Statutory citation)

The agency's legal authority to make rules and regulations that are binding on the political subdivisions administering the plan is:

(Statutory citation)

Date:

Signa ture

MflJ!l!!J1 c�

TN No. 13-0017 Supersedes TN#: 95-06

Title

Approval Date: September 16, 2016 Effective Date: --------

October 1, 2013

Cabinet Secretary

WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES

Bureau for Medical Services

Deputy Secretary of Behavioral Health and Human Services

Deputy Secretary of Public Health, Insurance and Strategic Planning

Director of Communications General Counsel

Assistant to the Secretary

Chief Information

Chief Operating Officer

Inspector General

Director of Human Resources ManagementBureau for Medical

ServicesCommissioner

Assistant to the Commissioner

Legal & Regulatory

Division of Operations

Management Deputy

Commissioner

Division of Finance & Administration

Deputy Commissioner

Division of Policy Coordination

Deputy Commissioner

Medical and ClinicalDirector

PersonnelDirector

Program IntegrityDirector

HIPPA & Reporting

Quality UnitDirector

Procurement ActivitiesDirector

Budget & Accounting ServicesDirector

Home & Community Based Services

Director

Facility Based & Residential Care

Director

Pharmacy Services and Drug Rebate

Director

Professional Health ServicesDirector

Managed CareDirector

MFP Program Director

Policy Administrative Services Director

Transportation Services Director

Special ProjectsDirector

Member Eligibility Director

TN No. 13-0017 West Virginia

Approval Date: September 16, 2016 Effective Date: October 1, 2013